ANKLE SPRAINS. Explanation. Causes. Symptoms

Transcription

1 ANKLE SPRAINS Explanation Ankle sprains occur when ligaments in the ankle are partially or completely torn due to sudden stretching, either laterally or medially, or when the ankle is suddenly twisted as is common in sports injuries or with poor balance. The body s immediate reaction includes sudden, severe pain and swelling of the ankle. While partial tears may retain some stability, complete tears do not as the ligaments are no longer able to brace the ankle joint. Lateral (outer) ankle sprains are more common than medial (inner) ankle sprains due to common movement mechanics when performing day-to-day activities. The lateral ligament is also smaller and more fragile. An ankle sprain is the most common sports injury, and the severity of the sprain is classified in three different grades. Grade 1 sprains are mild and usually reflect stretching of the ligament fibers. Grade 2 ankle sprains are moderate in severity and characterized by both stretching and tearing of ligament fibers. Grade 3 ankle sprains involve complete tearing of one or more ligaments. Causes Ankle sprains occur when the foot turns unnaturally, placing the body weight on the ankle ligaments. Lateral sprains occur when the lower leg rolls outward over the ankle, pressing the bottom of the foot inward. Medial sprains occur when the lower leg rolls inward over the ankle, pressing the bottom of the foot outward. Many patients report a popping or snapping sound followed by severe pain. Ankle sprains can often occur as a result of an awkward, unbalanced, or particularly forceful landing from a jump or vault, though it can also be sprained through less strenuous activities such as walking. Symptoms Symptoms of an ankle sprain include instant, severe pain, rapid swelling (within the first few minutes), and discoloration of the ankle (within 5-20 minutes). The amount of swelling and discoloration depend upon the severity of the damage to the ligament as well as to its surrounding blood vessels. Pain is generally greatly increased when weight is pressed on the sprain; therefore, patients may walk with a hobble or limp, or in more severe cases, be unable to put pressure on the sprain at all. Weight bearing by the affected foot is usually very painful, though a Grade 1 sprain might briefly accept some weight, resulting in a hobble. The amount of swelling and discoloration depends on severity of 1

2 damage to the ligament and to adjacent blood vessels. Range of motion of the afflicted ankle is reduced immediately because of pain, and subsequently reduced due to swelling. Diagnosis Your health care provider will review conditions surrounding the injury as well as manipulate and perform tests on the ligaments in order to determine the severity of the injury. With Grade 2 and 3 sprains, x-rays may be taken to ensure that a fracture has not occurred, and follow-up visits may be necessary for sprains with severe swelling. Treatment During the first 48 hours following injury, treatment should consist of significant rest, ice (cold application), compression, and elevation (RICE). Early mobilization is helpful as well. Cold application and compression are beneficial in constricting damaged blood vessels and controlling swelling. Elevation also aids in this as it prevents the pull of fluid to and through ruptured capillaries in the injured area. However, swelling may still be considerable despite these efforts. For Grade 1 sprains, the RICE treatment plus support provided by a brace or bandage for 2-3 weeks, is typically sufficient for rehabilitation of the ankle. Be careful to avoid overprotection of injury, as use of and weight-bearing (once pain has reduced) is therapeutic and beneficial to recovery. For Grade 2 sprains, the RICE treatment proves beneficial as well; however, a Grade 2 sprain usually requires a longer period of rest, 3-4 weeks, and often a stiff brace. Weight-bearing should be much slower and more gradual with Grade 2 sprains (only as reduction of pain permits), and crutches may be initially required. For Grade 3 sprains, 48 hours of initial RICE treatment is essential. A stiff brace, or even a cast, may be required. The use of crutches is typically required to avoid the severe pain of weight-bearing, and weightbearing should only occur very gradually and only as the reduction of pain allows. In more severe cases, surgery may be required to stabilize the joint. Lasting Effects Patience is the key to a full recovery. Pushing the injury too much or too quickly (such as too much weight-bearing too soon) will only hinder your recovery. For Grade 1 sprains, the ankle is usually full rehabilitated within 2-4 weeks. For Grade 2 sprains, 2-6 weeks, and for Grade 3 sprains, generally 2-8 weeks, though the pain of weight-bearing has been known to persist for months following injury. Healing Time and Return to Play Again, patience is the key. Returning to activity too soon can lead to a more serious injury or severe recurrence of the original sprain. Pain is the best indicator for when you can return to sports and activities, along with the input of your health care professional. If gentle movements are painless, more vigor can be introduced on a gradual scale. If pain is present with gentle movements, then more vigorous activities should be avoided entirely. The best option is to allow thorough recovery of the sprain before returning to the original sport or activity. For full participation, you should wait for Grade 1 sprains, 2-4 weeks. For Grade 2 sprains, 6-8 weeks, and for Grade 3 sprains 2-3 months (and should be monitored by your health care professional). 2

3 Prevention Prevention can be difficult with common injuries such as ankle sprains; however, there are some preventative measures that can be taken. Avoiding surfaces and equipment in poor condition can be beneficial in prevention (such as sports fields with holes or courts with cracks, and shoes that are worn or broken). There are also some rehabilitative exercises for those who have suffered previous ankle sprains that can help to prevent future sprains. These exercises are described below. Rehab Recommendations With Grades 1 and 2 sprains, rehabilitation can begin almost immediately with limited range of motion. For starters, begin by elevating the lower leg onto a chair or table with the foot hanging over. Then gently move the foot through as much of its range of motion as pain and swelling will allow. Some discomfort will be present, but never move to a point of pain. With each passing day, greater ranges of motion should be achieved. With most sprains, including Grade 3 sprains, rehabilitation can begin after three weeks. SOLEUS STRETCH 1. From a standing position, step one leg back inches. 2. Begin stretch by flexing the front knee and pushing the heel of the back foot toward the floor while maintaining a slight flexion in the back knee. If you begin feel more stretch in the calf, bend that back knee a little more. 3. Hold statically for 5-10 seconds. DORSIFLEXION PASSIVE STRETCH 1. Begin by sitting on a comfortable surface with one leg fully extended, then flex the knee of the other leg and place foot next to the inner thigh of the extended leg. 2. Loop a towel or strap around the foot of the extended leg while grasping both ends of towel. 3. Begin stretch by leaning back and allowing the towel to flex the foot back while maintaining a firm grip on the towel. 4. Upon feeling a good stretch in the foot and ankle, hold for 5-10 seconds then slowly release. 5. Repeat steps 3 and 4 for several reps and do this stretch 2 or 3 times each day, depending on the extent of the injury. Helpful hints: If there is still significant pain the foot and/or ankle, you may need to stay off that foot for a bit longer. 3

4 The next three exercises will require the use of elastic bands that can come in the form of looped bands, thera-bands and tubing. These come in varying thicknesses for varying degrees of resistance. As the level of resistance becomes too easy, upgrade to a thicker band for a greater resistance. SEATED BAND PLANTARFLEXION 1. Begin by sitting on a comfortable surface with one leg fully extended, then flex the knee of the other leg and place foot next to the inner thigh of the extended leg. 2. Loop a resistance band (preferably a Theraband or looped band, but a regular resistance band can work) around the foot of the extended leg while grasping both ends of band. 3. Begin Plantarflexion by extending your ankle as you push the toes forward. 4. When fully extended, hold for 3-5 seconds then slowly release. 5. Repeat steps 3 and 4 for prescribed number of reps. ANKLE BAND EVERSION 1. Sit up on a table or any comfortable surface with both legs fully extended with feet close together. 2. Loop a resistance band (preferably a looped band, but a regular resistance band can work) around the outer edges of both feet up close to the toes. 3. Sit up comfortably and set feet 6-8 inches apart. (Starting position) 4. Begin Eversion motion by turning the injured foot/ankle away from the other foot against the resistance of the band as far as the foot/ankle will comfortably allow. 5. From the everted position, slowly reverse the motion under control and return the foot back up to the starting position. 6. Repeat for prescribed number of reps. ANKLE BAND INVERSION 1. Sit up on a table or any comfortable surface and place the leg with the injured foot/ankle on top of the other leg. 2. Loop a resistance band (preferably a looped band, but a regular resistance band can work) around the inner edges of both feet up close to the toes, then sit up comfortably. (Starting position) 3. Begin Inversion motion by turning the injured foot/ankle away from the other foot against the resistance of the band as far as the foot/ankle will comfortably allow. 4. From the inverted position, slowly reverse the motion under control and return the foot back up to the starting position. 5. Repeat for prescribed number of reps. 4

5 Once you get over much of the pain and discomfort, you can add the following strengthening exercises to strengthen the lower leg and ankle. Jogging and running should be approached with much care and discretion. BODY WEIGHT CALF RAISE 1. Begin by placing only the balls of your feet on the calf block and hands on another object (bench, rack, wall, etc.) for stability. 2. Stand erect by fully extending the hips and knees and stretching the calves/heels down into the bottom, starting position. 3. From the bottom position, exhale as you raise the heels by extending ankles and coming up on the balls of your feet as high as you can go, while keeping the knees locked and maintaining an erect posture. Be sure to keep the heels in and toes out throughout motion. 4. Once at the top, slowly reverse the motion by lowering your heels and stretching the calves back to the bottom, as you inhale and prepare for the next rep. Helpful hints: A rounded calf block is preferred when performing any type of Calf Raise, which is much more comfortable on the feet. If that s not an option, wearing thick cushioned shoes will help. SINGLE-LEGGED CALF RAISE 1. Position only the ball of one foot on top of the calf block pointing straight ahead and place the opposite foot on the soleus of the leg being worked. Stand erect and place your hands on a stable object for balance. 2. Starting from the bottom, raise the heel and extend the ankle of the working leg into the top position as far up as you can go. 3. From the top position, inhale as you lower the heel and stretch the ankle of that leg back to the bottom. Helpful hints: Be sure to keep the toes pointing straight ahead, as the foot will want to turn out. 5